Search Results (1,702)

This paper focuses on whether smart-related built environments are associated with improved housing affordability for economically disadvantaged groups. Smart growth is a planning theme that aims to address the unintended negative consequences of urban sprawl through combining diverse dimensions across land-use diversity, housing diversity, accessibility, and compact development. Focusing on Clackamas County, Multnomah County, and Washington County within the Portland metropolitan area, the analysis uses census-tract-level data to assess both contemporaneous associations in 2013 and changes in affordability between 2013 and 2019. Overall, the findings suggest that smart-growth tools exhibit both potential and limitations with respect to housing affordability. Greater housing-type diversity and lower reliance on single-family residential land use are consistently associated with higher shares and subsequent increases in affordable housing units for low-income groups. In contrast, other smart-growth features—such as land-use mix and accessibility—show weaker or uneven relationships. These findings suggest that smart growth can contribute to expanding affordable housing supply primarily through housing-related components, while other dimensions of smart growth appear to play a limited role. The results underscore that housing-focused strategies play an important role in shaping affordability outcomes under smart growth. Full article

This paper presents a scalable and low-cost Retrieval Augmented Generation (RAG) architecture designed to enhance learning in university-level courses, with a particular focus on supporting students from economically disadvantaged backgrounds. Recent advances in large language models (LLMs) have demonstrated considerable potential in educational contexts; however, their adoption is often limited by computational costs and the need for stable broadband access, issues that disproportionately affect low-income learners. To address this challenge, we propose a lightweight, mobile, and friendly RAG system that integrates the LLaMA language model with the Milvus vector database, enabling efficient on device retrieval and context-grounded generation using only modest hardware resources. The system was implemented in a university-level Data Mining course and evaluated over four semesters using a quasi-experimental design with randomized assignment to experimental and control groups. Students in the experimental group had voluntary access to the RAG assistant, while the control group followed the same instructional schedule without exposure to the tool. The results show statistically significant improvements in academic performance for the experimental group, with p < 0.01 in the first semester and p < 0.001 in the subsequent three semesters. Effect sizes, measured using Hedges g to account for small cohort sizes, increased from 0.56 (moderate) to 1.52 (extremely large), demonstrating a clear and growing pedagogical impact over time. Qualitative feedback further indicates increased learner autonomy, confidence, and engagement. These findings highlight the potential of mobile RAG architectures to deliver equitable, high-quality AI support to students regardless of socioeconomic status. The proposed solution offers a practical engineering pathway for institutions seeking inclusive, scalable, and resource-efficient approaches to AI-enhanced education. Full article

The growing economic pressures on healthcare systems have heightened the need for effective and sustainable cost management strategies. This study presents a PRISMA-based systematic review of 210 peer-reviewed articles published between 1974 and 2024, retrieved from the Scopus and Web of Science databases. Following a structured selection and screening process, the articles were analysed to identify dominant cost control tools, contextual applications, and methodological trends across diverse health systems. The findings highlight a strong prevalence of Activity-Based Costing (ABC), Diagnosis-Related Groups (DRG), and benchmarking practices, predominantly in public hospital settings. However, significant thematic gaps remain, particularly concerning low-income countries, interdisciplinary integration, and the evaluation of digital technologies for financial optimisation. This review provides a comprehensive thematic synthesis of international research, consolidating knowledge in healthcare cost management and offering evidence-based recommendations to guide future empirical research, policy design, and strategic planning in health finance. Full article

Informal settlements are widely present and important urban spaces, providing valuable living spaces for many migrant populations, low-income groups, and indigenous peoples. However, urbanization faces a common challenge: the transformation of informal settlements often destroys social structures and belongingness. Despite its importance, few studies have examined how redevelopment is correlated with original residents’ belongingness. To address this gap, this study proposes a research framework of belongingness structured along the logical chain of “network–node–subject”. Social network analysis (SNA) is employed to identify the existing outdoor activity space network and its key nodes. Exploratory factor analysis (EFA) is then conducted to determine the key environmental features of outdoor activity spaces that influence original residents’ belongingness. Furthermore, K-means clustering is applied to explore the correlation mechanism between space and belongingness across different age groups. This study identifies differentiated and universal elements by analyzing the clustered conflict factors, in order to provide precise policy insights. The findings provide actionable insights for enhancing residents’ belongingness during the redevelopment of informal settlements in cities. Full article

Background: Maternal health behaviors during pregnancy are crucial for maternal and fetal outcomes. While global research has explored that demographic, clinical, and psychosocial determinants significantly influence these behaviors, evidence from low- and middle-income countries (LMICs), including Albania, remains limited. This study aims to evaluate psychosocial perceptions and health behaviors related to lifestyle among pregnant women in a local Albanian community in order to identify which are higher risk subgroups that need targeted and tailored antenatal care interventions. Methods: This multicenter cross-sectional study included 200 pregnant women attending antenatal clinics from May to August 2024 in Vlora city, Albania. Participants were selected using consecutive sampling based on inclusion criteria. Data were collected through a validated questionnaire composed of five sections: demographic/obstetric data; maternal health behaviors; dietary diversity; physical activity, perceived stress; and social support. Clinical and anthropometric measurements were assessed by trained health professionals during antenatal visits. SPSS version 23.0 and binary logistic regression with p-value ≤ 0.05 statistically significant were used for data analysis. Results: Mean age was 28.3 ± 6.4 years, 71% employed and 83.5% urban residents. Key unhealthy behaviors included tobacco use (25.5%), alcohol consumption (10.5%), exposure to toxins (15%), and low dietary diversity (32%). We found significant correlations between low dietary diversity and rural residence (Adj OR = 2.48), hypertension (Adj OR = 6.88), and overweight/obesity (Adj OR = 2.33). Tobacco use was associated with unemployment and alcohol use with unemployment and hypertension variables. Low/moderate social support and high perceived stress were significantly related with multiple unhealthy behaviors, such as low dietary diversity, inadequate physical activity and antenatal care. Conclusions: Unhealthy nutritional behaviors, tobacco and alcohol use and low physical activity are more prevalent risk factors among pregnant women in Vlora city. Priority should be given to vulnerable groups, including rural residents, pregnant women with low social support, high perceived stress and those with hypertension and obesity. Interventions that integrate psychosocial support and health education into antenatal care services are urgently needed to enhance pregnancy outcomes in Albanian communities. Full article

Against the backdrop of rising farm household incomes alongside a widening internal income gap in rural China, investigating the impact of peer effects in ecological assistance (PEEA) on farmers’ policy satisfaction is crucial for formulating more targeted support policies and mitigating rural income inequality. Utilizing 2023 survey data from designated assistance counties of the National Forestry and Grassland Administration (NFGA) of China, this study employs methods such as Oprobit and moderation effects to examine the factors and mechanisms through which peer effects in ecological assistance affect farmers’ policy satisfaction. The results indicate that PEEA exert a negative influence on farmers’ policy satisfaction, a finding that remains robust after endogeneity checks using the conditional mixed process (CMP) model and residual analysis. The information transmission mechanism can strengthen the suppressive effect of these peer effects on satisfaction, whereas the social interaction mechanism exhibits a substitution effect with the peer effects. The peer effects are asymmetric, with a more pronounced negative impact on policy satisfaction among farmers over 50 years old and those with lower human capital. Furthermore, the peer effect is most significant for forestry property income, followed by forestry wage income and forestry operating income. Farmer groups with low-to-medium forestry income are more significantly affected by PEEA. Furthermore, among these, the medium forestry income cohort demonstrates the highest sensitivity to the influence of PEEA on policy satisfaction. Therefore, ecological assistance policies should be further optimized, and forestry income should be distributed equitably to enhance the sense of policy benefit and well-being among farmers. Meanwhile, information channels should be improved to guide rational interpersonal expenditure, target groups with strong peer demonstration effects, explore diversified forestry management projects, and broaden income-increasing channels through ecological assistance. Full article

Aims: Low-carbohydrate diets (LCDs) are associated with metabolic benefits, but their long-term effects remain uncertain, particularly in Asian populations with traditionally high carbohydrate intake. This study examined LCD patterns and their association with metabolic syndrome (MetS) in Korean adults using nationally representative data from the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Among 9617 adults aged ≥20 years with complete dietary and health data, LCD score was calculated from the percentage of energy derived from carbohydrates (reverse-scored), fats, and proteins, and participants were categorized into high-carbohydrate, moderate-carbohydrate, and low-carbohydrate groups. MetS was defined using an Adult Treatment Panel III and Korean criteria. Survey-weighted logistic regression was applied to assess associations between LCD score and MetS across sequentially adjusted models. Results: MetS prevalence differed significantly across LCD decile groups (LCD1: 9.6%, LCD2: 5.8%, LCD3: 9.7%; p < 0.001). In a minimally adjusted model, LCD decile 3 was associated with higher odds of MetS (OR, 1.14; 95% CI: 1.02–1.27). However, this association was attenuated and became non-significant after further adjustment for key metabolic risk factors. Obesity, blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were all strongly associated with MetS (all p < 0.001), and income-related disparities were evident, with lower-income groups showing higher carbohydrate and lower fat and protein intakes. Conclusions: These findings suggest that LCD patterns are not independently associated with MetS once underlying metabolic factors are considered. Public health strategies in Korea would be emphasized by improving nutrient quality, promoting balanced macronutrient intake, and reducing socioeconomic inequalities in diet to mitigate metabolic risk among adults. Full article

This article examines labor market dynamics in Bulgaria, Italy, and the United Kingdom by integrating demographic pressures, wage and labor cost adjustment, redistribution mechanisms, inequality outcomes, and digital readiness into a single comparative framework. This study first applies hierarchical clustering to a harmonized EU country panel for 2017–2024, using GDP per capita in PPS, average annual wage, and unemployment rate to position the three countries within the European convergence space and income–labor cost groupings. The results show that Bulgaria belongs to a low-income, fast-converging group, with nominal wages and hourly labor costs more than doubling, strong real-wage growth from a low base, and an improving price level index. At the same time, unemployment fell to below the EU average, yet income inequality remains persistently high. Italy represents a high-income but slow-growing labor market, in which real wages have declined, and labor costs per hour remain above the EU mean with a significant non-wage component. Unemployment remains relatively elevated, indicating divergence in workers’ purchasing power despite high income levels. The UK has labor costs in the mature high-income range, low unemployment, and the lowest tax wedge for low-wage workers, but with relatively high and volatile inequality. This study shows that wage dynamics, labor cost composition, and tax–benefit structures jointly mediate the translation of macroeconomic performance into household outcomes, generating distinct policy trade-offs across the three labor market configurations. Digital indicators further suggest that income level is not a sufficient predictor of digital engagement and that the observed aggregate labor market trends do not indicate a sharp employment contraction contemporaneous with the diffusion of technical innovations, such as generative AI. Full article

Background/Objectives: This study aimed to determine the antimicrobial susceptibility patterns of multidrug resistant (MDR) and extensively resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) strains among children, along with the associated behavioral and environmental risk factors across different population groups in multiple districts of Punjab, Pakistan. Methods: A cross-sectional study was conducted across 20 districts in Punjab, Pakistan. Structured questionnaires were used to assess sociodemographic and behavioral determinants. Blood cultures from febrile children were obtained for the isolation and identification of S. Typhi, followed by antimicrobial susceptibility testing and screening for the resistance genes. Results: A total of 900 blood samples were collected and 41.5% were positive for S. Typhi. The proportion of culture-positive cases were higher among children aged 6–12 years (34.8%). Sociodemographic and behavioral analysis revealed that children from low-income households (PKR < 20,000 showed significantly higher infection rate (67.1%, p < 0.001). Antimicrobial susceptibility testing revealed high resistance rates against several antibiotics: Ciprofloxacin (88.8%), Trimethoprim/sulfamethoxazole (83.7%), Ampicillin (73.8%) and Chloramphenicol (72.7%). However, all isolates remained susceptible to carbapenems and azithromycin. The prevalence of MDR and XDR S. Typhi in urban areas was 28.1% and 60.8%, respectively, while rural areas showed 22.6% MDR and 20.6% XDR. In contrast, nomadic populations exhibited a higher rate of MDR (49.3%) but a lower XDR prevalence of 18.6% with significant geographic variations in resistance patterns. Molecular analysis revealed a high prevalence of resistance genes, including sul1 (83.7%), sul2 (79.7%), followed by dfrA7 (81.3%), catA1 (64.9%) and bla_TEM (60.5%), bla_CTX-M-1 (12.5%), bla_CTX-M-15 (25.9%) and qnrS (88.8%), respectively. Conclusions: The study underscores a persistent typhoid burden and widespread antimicrobial resistance among children in Punjab. Targeted vaccination, antibiotic stewardship, public health education are urgently needed, especially among the nomadic population, where healthcare access and hygiene awareness are limited. Full article

Group A rotaviruses (RVAs) remain the leading cause of acute gastroenteritis (AGE) in young children in low- and middle-income countries. In Brazil, the oral attenuated RVA vaccine (Rotarix^®), monovalent genotype G1P[8], is distributed by the national immunization program and has drastically reduced morbidity and mortality associated with RVA etiology. In this study, Rotarix^® G1P[8] was detected using specific qRT-PCR from the fecal shedding of children living in the Amazon region, and 18.3% (29/158) were positive and 75.8% (22/29) presented with AGE. The VP4 (VP8*) gene of these sheddings, submitted to Sanger nucleotide sequencing, showed an occurrence of mutations, including the silent mutation at 144C > G (one child) and the following missense mutations— 499T > C (F167L) (two children), 644G > C (C215S) (one child), and 787G > A (E263K) (one child). These mutations had no impact on the protein model structure in silico deduced from the VP4 (VP8*) mutants. The in silico protein model deduced from the VP4 (VP8*) nucleotide sequences, bound to type 1H sugar antigens (H1) and its precursor Lac-para-N-biose (LNB), had a stronger binding to the G1P[8] genotype, when compared to G3P[8]. Rotarix^® shedding was higher in HBGA secretors than in non-secretors (79.3%; 23/29). A total of 11.4% (18/158) of children with Rotarix^® G1P[8] shedding were unvaccinated, indicating the occurrence of indirect protection. Stability evidence of Rotarix^® VP4 (VP8*) spike protein from samples collected in vivo is presented. Full article

Background/Objectives: Gastroenteritis remains a major global health concern, particularly in resource-limited regions, where rapid and accurate diagnosis is crucial for effective patient management. Syndromic multiplex PCR panels, such as the FilmArray gastrointestinal (FAGI) panel, offer the potential to significantly improve diagnostic yield and turnaround time, enabling more targeted treatments and reducing unnecessary antibiotic use. However, real-world data on their performance in low-resource settings remains scarce. This study evaluates the performance, clinical impact, and cost-effectiveness of the FAGI panel compared to standard of care (SOC) diagnostic methods in gastroenteritis cases at São José Hospital for Infectious Diseases in Fortaleza, Brazil, an HIV Reference Center, in a resource-limited region of a middle-income country. Methods: A retrospective observational study was conducted among patients tested with FAGI (n = 161) and a retrospective control group tested only with SOC methods (n = 166). Results: The FAGI panel was associated with a significant reduction in the turnaround time, antimicrobial use, and total treatment costs while increasing the pathogen detection rate. Specifically, the median diagnostic time was reduced by 18%, with an increase in pathogen detection compared to SOC methods (64% positivity compared to 32%). Moreover, the FAGI group experienced a 30% reduction in antibiotic use, with a corresponding 83% reduction in antimicrobial costs. Conclusions: These results suggest that the FilmArray panel may offer substantial benefits in terms of efficiency and cost savings, highlighting its potential for broader implementation in clinical practice, especially in resource-limited settings, to improve patient outcomes in infectious disease management. Full article

Climate action has been deemed as fundamental to counteract the impacts of rising global temperatures on health which will disproportionately affect low-income populations, racial and ethnic minorities, women, and other historically marginalized groups. Along with poverty reduction, inequality mitigation, gender equality promotion, and public health protection, climate action has been recognized as a fundamental goal for achieving Sustainable Development Goals (SDGs). However, despite growing recognition of the need to align climate action with development goals, there is a knowledge gap regarding how the implementation of climate change mitigation and adaptation policies impacts social inequalities. To address this knowledge gap, this document proposes a scoping review protocol aimed at identifying and synthesizing research that examines the impacts of climate policies on inequalities at the subnational scales, within the transport, infrastructure and health. The objective of this review is to map existing evidence, identify conceptual and empirical gaps and inform policy strategies that promote climate action in line with values of social justice and equality. Full article

The agroecological (AE) transition of agri-food systems can help address climate change impacts in Tunisia, including reduced local food production and high import dependency, but it requires understanding consumer behavior toward eco-friendly food products. Thus, a survey of 521 Tunisian consumers was conducted to assess environmental awareness and willingness to pay (WTP) for food produced under AE practices. Principal Component Analysis (PCA) indicated that sustainable consumption is mainly influenced by knowledge of AE practices, which is stronger among consumers with higher education and income. However, WTP for sustainable products remains low, making it essential to develop marketing strategies that target distinct demographic groups, improve product labeling, and enhance environmental education. Full article

Evaluating the effect of recycling Pesticide Packaging Waste (PPW) is essential for improving recycling rates, which plays a crucial role in controlling environmental pollution and optimizing the efficiency of agricultural resources worldwide. Based on the micro-survey data of 1223 farmers in Yunnan and Hainan provinces of China, this study measures the economic effect by the farmers’ annual total household income and the ecological effect by the ecological environment quality of villages. The propensity score matching method (PSM) is employed to empirically test the economic and ecological effects of farmers’ recycling behavior of PPW and their differences. The research findings are as follows: Farmers’ recycling of PPW can generate significant positive economic and ecological effects, which are 116.7% and 4%, respectively. The heterogeneity analysis shows that farmers with a low degree of land fragmentation have a more obvious economic effect from PPW recycling, while farmers with a higher degree of land fragmentation have a more significant ecological effect; farmers with high pesticide costs have more significant economic and ecological effects from PPW recycling. Based on these findings, it is suggested to increase the attention at the policy level, enhance farmers’ environmental awareness and capacity, and focus on the characteristics of different groups. Full article

In urban design, public open spaces (POS) are essential for enhancing health and well-being across the lifetime. High-quality public open spaces facilitate the maintenance of optimal physical and mental health in older individuals by encouraging activities like physical exercise and social engagement. Preserving the physical and mental well-being of elderly individuals is a fundamental concern for aging policy. Nevertheless, urbanization presents considerable problems with the provision of public open spaces for activities aimed at the elderly. South Korea has more significant issues than other nations globally. This study, based on data from 477 valid questionnaires collected in and around Tapgol Park in Jung-gu, Seoul, employed a decision tree approach to identify key factors and paths that influence overall satisfaction. The goal was to identify decision paths that improve satisfaction while ensuring interpretability, thereby providing a scientific basis for urban space design and renovation. The results show that: (1) The decision tree of this study presents a hierarchical logic of quietness first, then accessibility and cleanliness, and finally price and vitality, which is consistent with the high frequency of use of Tapgol Park by the elderly and the diverse facilities in the surrounding area. (2) The key to improving the management and satisfaction of Tapgol Park in Seoul is the quietness of the site. (3) When the park is not quiet, users are most sensitive to bottom-line factors, such as commercial supply, evacuation safety, transportation accessibility, price perception, barrier-free, and anti-slips. (4) When the park is quiet, basic comfort factors such as smooth walking, all-day opening, sunlight, and no odor constitute the minimum condition set for entering the comfort zone. (5) Water experience, waterfront accessibility, proximity to cultural resources, and moderate business and community-oriented leisure facilities are key plus points. Methodologically, this study is among the first to apply a decision tree approach to low-income elderly using a small public open space in a historic city center, clarifying the nonlinear and hierarchical relationships among environmental factors within these low-income elderly groups. This provides empirical support and reference for the aging-friendly urban space in world heritage cities and other historical and cultural cities. Full article